New prevention guidelines released at the American College of Cardiology Annual Scientific Session in New Orleans include information on heart-healthy diets, exercise regimens, and other preventive steps.
The 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Primary Prevention of Cardiovascular Disease guidelines, offer a comprehensive overview of the and useful recommendations for clinicians for the prevention of cardiovascular disease. According to a press release accompanying the Guidelines, nearly one out of three deaths in the United States can be attributed to cardiovascular disease.
“The most important way to prevent cardiovascular disease, whether it’s a build-up of plaque in the arteries, heart attack, stroke, heart failure or issues with how the heart contracts and pumps blood to the rest of the body, is by adopting heart healthy habits and to do so over one’s lifetime,” said Roger S. Blumenthal, MD, co-chair of the 2019 ACC/AHA Guidelines and the Kenneth Jay Pollin Professor of Cardiology at Johns Hopkins Medicine, in a press release. “More than 80% of all cardiovascular events are preventable through lifestyle changes, yet we often fall short in terms of implementing these strategies and controlling other risk factors.”
Risk Assessment
Dr. Blumenthal said that the new guidelines can provide a roadmap of treatment and prevention strategies that can be customized and tailored to patients without histories of heart disease. The guidelines also identify “social barriers” such as income, education level, cost concerns, lack of insurance, healthy food access, and others, as potential challenges for consistent application and compliance with guidelines.
The concept of comprehensive risk assessment was one of the important topics addressed by the new Guidelines. Primary prevention, according to the press release about the Guidelines, should be openly discussed by patient and their care team to address any personal habits or personal risks for that patient. The goal is to apply the most current evidence while balancing any personal preferences. The Guidelines include the most up-to-date clinical data on proven lifestyle interventions for improving exercise routines, diet, help for tobacco cessation, and more.
“We have good evidence now for how to identify these very high risk individuals with a physical exam and a good history, and for those at borderline risk there are additional factors that can help us determine who is at greater risk and should, for example, be on a medication like a statin earlier to prevent a cardiovascular event,” Blumenthal said. “In the past, a lot of people may have had a fatalistic attitude that they were going to develop heart problems sooner or later but, in reality, most cardiovascular events can be prevented.”
Lifestyle Mods and Aspirin
The Guidelines also highlighted recent research and underscored the importance of lifestyle modifications, which include eating healthier, engaging in regular exercise, keeping a health weight, and avoiding tobacco products. People with type 2 diabetes can look forward to the addition of recent data suggesting that two common medications (metformin and sodium-glucose cotransporter 2 inhibitors) can help lower blood sugar levels, as well as help cut the risk for heart attack, stroke, and related mortality.
The new Guidelines also explore aspirin use for prevention. According to the press release, clinical research in this area suggests that aspirin is not commonly used to prevent heart attack or stroke in people with identified cardiovascular disease. Recently published research suggests that the bleeding risk caused by daily aspirin, which was once thought to help prevent adverse events, outweighs the potential benefit. Patients at high risk for stroke or heart attack who are taking statins for primary prevention are recommended to review their medical history and have a careful conversation with their clinician.
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